Sweating In a Colder Clime

Three treadmill workouts to keep you in shape and far from bored this winter.
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Winter Sports That Match Running in METs

Three cold weather crosstraining activities that roughly match the exertion level of running 10-minute miles.
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Milk, Mortality and Fracture Prevention

Adult women who reported drinking three or more glasses of milk daily had a near doubling of risk for total mortality.
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Understand Probability to Make Smarter Health Choices

Understanding conditional probability allows you to better interpret diagnostic test results and make wiser treatment choices.
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Striving for Symmetry

Gross imbalances in strength and flexibility between your right and left sides could lead very quickly to injury.
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Comparing 5 Diets on Long-Term Efficacy

A study looking at thousands of Nurses' Health Study participants associated the Mediterranean diet with a key indicator of healthy aging.
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The Clinic

Surprised By Stroke, Seeking a Way Back to Running
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Long-Running Toe Pain
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Going Shoeless Should Be Gradual
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Knee-Healing Strategies for an Ex-Competitor
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The Back Page

XC BORDER WAR 9:  TEAM MARYLAND reigns supreme along the Potomac

Running for the AMAA YOUTH FUND 2015 – A few slots remain to help our Team

Post-race or competition massage. When is it beneficial?

Transition from Cross Country to Indoor Track: A coach’s perspective.
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Consumer Reports Weighs In on Gluten

Gluten-free food advertising is everywhere. There is, after all, an extremely robust market for these products. According to a survey conducted by the nonprofit, independently-funded consumer watchdog group Consumer Reports, a majority of Americans now believe a gluten-free diet would improve their health. A subset of this group consists of still millions of Americans who believe they must desist all gluten consumption—the survey found 33% of its respondents buy gluten-free products and actively try to avoid gluten. These are not Celiac disease patients or, the numbers show, even those diagnosed with gluten sensitivity. The number of people estimated to have genuine gluten sensitivity is far, far lower—less than 7% of all Americans. All this might be harmless, but it turns out for non-gluten sensitive people, cutting out gluten is decidedly less nutritious than leaving it in the diet.

A quarter of the people Consumer Reports surveyed thought gluten-free foods have more vitamins and minerals than other foods. But the organization's detailed review of 81 products free of gluten across 12 categories revealed they are too often not enriched or fortified with nutrients such as folic acid and iron, as many products that contain wheat flours are.

In an article from the Harvard Health Letter dating back to 2009, concerns over gluten-free products containing a lot of empty calories and fewer nutrients were raised:

“The gluten-free diet has traditionally depended on starch from rice, corn, and potatoes. Food makers have also learned how to use xanthan and guar gums to replace gluten's elasticity: a common complaint about gluten-free baked goods is that they are powdery. But these formulations can also leave diets short of fiber and B vitamins.”

Gluten is a protein found in wheat, barley and rye, and for years now it has been blamed for problems as diverse as forgetfulness, joint pain and weight gain. This last one seems to be a major reason people go gluten-free. According to the recent survey, that same third of people who restrict gluten do so because they think that going gluten-free will help them slim down. Unfortunately, there’s very little evidence that doing so is a good weight-loss strategy; in fact, the opposite is often true. Eliminating gluten often means adding sugar, fat and sodium, which are commonly used to compensate for flavor and texture in these foods, like the empty calories of xanthan and guar gums only worse: sugar and fat also add more calories that could cause some people to actually gain weight on these “diets.”

Apart from weight loss, among the top benefits of going gluten-free that respondents cited were better digestion and gastrointestinal function, increased energy, lower cholesterol and a stronger immune system.

A Gene's Eye View of Health as Buying Time

Recently researchers have identified an important genetic component to heart health, a result of their continued exploration of the role of LDL (“bad” cholesterol) in the body. The discovery is startling because of its specificity: the large genetic study published in November in NEJM has identified 15 rare mutations that block the activity of a specific gene, Niemann-Pick C1-Like 1 (NPC1L1). People who carry one of these genetic mutations enjoy a significantly lower LDL level than non-carriers (the mean lowered amount in the study was 12 mg/dL).

The practical implications are even clearer: The carriers of the mutations had a 53% risk reduction specifically in coronary heart disease, as compared to non-carriers of a NPC1L1-blocking mutation. This large of a reduction in heart disease risk was previously not known. NPC1L1 is the same gene that is blocked by the cholesterol-lowering drug ezetimibe. We now have a glimpse at the potential of the drug, due to the identification of the mutations.

Ezetimibe lowers plasma levels of LDL cholesterol by inhibiting the activity of NPC1L1. By studying human mutations that inactivate this gene and then looking at data on their health outcomes, we can now infer the specific potential effects of the drug.

There is one final, important point to be made about the role of the discoveries in heart health advisories going forward, and it is easy to overlook. The senior author of the study comments: "One of the key concepts here is that it may not be 'how you lower LDL' or 'how low you take LDL' but rather 'how long the LDL is lowered.' We should think about LDL like we do smoking. Smoking is typically quantified as 'pack-years,' a product of the number of years smoked times the number of packs per day. The concept to stress may be 'LDL-years.'"

The focus on this concept is not unlike the conclusions drawn from a lifetime of work by Steven N. Blair, P.E.D., with colleagues at the Cooper Aerobics Clinic in Dallas, and geriatrician Walter Bortz II, that have analyzed huge numbers of available statistics on aging and death and now assess potential longevity directly in terms of exercise years.

In 1989, Blair's seminal paper, “Physical Fitness and All-Cause Mortality,” reported to the world the direct relationship between how long you will live and how fit you are. By analyzing data from over 13,000 people over more than a decade, he has determined what percentage, on average, each of several factors contributes to our mortality.

The prospective study Blair conducted examined physical fitness and risk of all-cause and cause-specific mortality in 10,224 men and 3,120 women who were given a preventive medical examination. Physical fitness was measured by a maximal treadmill exercise test. The study notes that average follow-up was slightly more than 8 years, for a total of 110,482 “person-years” of observation. There were 240 deaths in men and 43 deaths in women.

The authors report: “Age-adjusted all-cause mortality rates declined across physical fitness quintiles from 64.0 per 10,000 person-years in the least-fit men to 18.6 per 10,000 person-years in the most-fit men (slope, -4.5). Corresponding values for women were 39.5 per 10,000 person-years to 8.5 per 10,000 person-years (slope, -5.5). These trends remained after statistical adjustment for age, smoking habit, cholesterol level, systolic blood pressure, fasting blood glucose level, parental history of coronary heart disease, and follow-up interval.”

Lower mortality rates in higher fitness categories were seen specifically for cardiovascular disease and cancer. Also, low fitness level was an important risk factor. The study concludes, “Higher levels of physical fitness appear to delay all-cause mortality primarily due to lowered rates of cardiovascular disease and cancer.”

Human aging is plastic, contends Walter Bortz, after carefully looking at Blair’s data and drawing a thoughtful and quite important distinction between aging and disuse, in 1982, seven years before Blair’s published work in JAMA. The essential idea of that paper, called “Disuse and Aging,” and also published in JAMA, is that what often passes for aging isn't aging, but disuse. Dr. Bortz is fond of saying that aging is not a disease; it isn’t something to be treated. He points to the second law of thermodynamics. Aging is the effect of an energy flow on matter over time. It ultimately is entropy, heat loss. We as organisms capture energy, and how effectively we use oxygen is in Walter’s view our central biomarker.
Finally, there is aging itself. In a paper entitled, “How Fast Do We Age?” Bortz plotted age-related decline across athletes aged 20 to 70. No matter their sport, the athletic records revealed the same statistical reality for all: Aging itself cost ½ of a percentage point per year in human wellness. Everything ages: cars, people, canyons. The exciting, empowering central idea is that the rate of loss is entirely knowable.

Bortz invites us to consider that once you’ve lost 70% of your fitness, symptoms begin—shortness of breath, musculoskeletal frailty, etc. This is the point of contact with the medical system for most people; they become patients, but with only 30% left in their health bank accounts. Ten percent later, they might well be dead.

He puts it succinctly: If at age 30 you have 100% of your health, at age 80 you would have necessarily lost only 25%—if you are fit. Blair’s data shows, on the other hand, that if you are unfit, you lose 2% per year of your health. Your “health” in this context simply means what you’ve been naturally given to let you live as long as that ½ percent per year loss due to aging will allow. We falter, contends Bortz, by succumbing to inactivity.

NEJM, 2014, Vol. 371: pp. 2072-2082, http://www.nejm.org/doi/full/10.1056/NEJMoa1405386

“The Plasticity of Human Aging,” July 2012, Walter Bortz II, MD, Trinity College Dublin lecture, http://www.youtube.com/watch?v=gtQBKfTjl5s&feature=plcp

JAMA, 1989, Vol. 262, No. 17, pp. 2395-2401

editorial board

Kenneth Cooper, MD
Kevin Beck
Jack Daniels, PhD
Randy Eichner, MD
Mary Jo Feeney, MS, RD
Mitchell Goldflies, MD
Paul Kiell, MD
Sarah Harding Laidlaw, MS, RD
Paul Langer, DPM
Douglas Lentz, CSCS
Todd Miller, MD
Gabe Mirkin, MD
Col Francis O’Connor, MD
Stephen Perle, DC, CCSP
Pete Pfitzinger, MS
Charles L. Schulman, MD
Bruce Wilk, PT, OCS
Mel Williams, PhD
Michael Yessis, PhD
Jeff Venables, Editor

board of directors

Jeff Harbison, President
Bill Young, Secretary-Treasurer
Immediate Past-President
(Vacant) Vice President
Robert Corliss
Charles L. Schulman, MD, AMAA Pres.
AMAA President
Terry Adirim, MD, MPH
Gayle Barron
Sue Golden
Senator Bill Frist, MD
Jeff Galloway
Jeff Harbison
Ronald M. Lawrence, MD, PhD
Jeff Moore
Noel D. Nequin, MD
David Pattillo

Association Staff

Executive Director: Dave Watt
Project Consultant: Barbara Baldwin, MPH

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